DaVinci Payer Data Exchange (PDex) US Drug Formulary
2.0.1 - STU 2
DaVinci Payer Data Exchange (PDex) US Drug Formulary
2.0.1 - STU 2
This page is part of the US Drug Formulary (v2.0.1: STU 2) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions
| Official URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PayerInsurancePlan | Version: 2.0.1 | |||
| Standards status: Trial-use | Computable Name: PayerInsurancePlan | |||
The Payer InsurancePlan that defines the health insurance product, which include coverage benefits that are offered, and additional information about the offering, such as a coverage area, contact information, brochure locations, etc. The health insurance product offers one or more types of coverage, each of which may define a plan of covered benefits with the particular cost sharing structure offered to a consumer. Health insurance plans that include drug coverage reference a formulary that provides details about drugs that are covered under the plan including requirements and limitations of the coverage specific to each drug.
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from InsurancePlan
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  InsurancePlan | 0..* | InsurancePlan | Details of a Health Insurance product/plan provided by an organization | |
  meta | ||||
  lastUpdated | S | 1..1 | instant | When the resource version last changed |
 identifier | S | 1..* | Identifier | Business Identifier for Product |
| status | S | 1..1 | code | draft | active | retired | unknown |
| type | S | 1..1 | CodeableConcept | Product type Binding: Insurance Product Type VS (extensible) |
| name | S | 0..1 | string | Official name |
| period | S | 0..1 | Period | When the product is available |
 coverageArea | S | 0..* | Reference(Insurance Plan Location) | Where product applies |
| contact | 0..* | BackboneElement | Contact information for the Insurance Plan including URLs for brochure and formulary information | |
| purpose | 0..1 | CodeableConcept | The type of contact Binding: Type of plan contact (extensible) | |
| name | S | 0..1 | HumanName | A name associated with the contact |
| text | S | 0..1 | string | Text representation of the full name |
 telecom | S | 0..* | ContactPoint | Contact details (telephone, email, etc.) for a contact |
 system | S | 0..1 | code | phone | fax | email | pager | url | sms | other |
| value | S | 0..1 | string | The actual contact point details |
 Slices for coverage | S | 1..* | BackboneElement | Coverage details Slice: Unordered, Open by pattern:type |
 coverage:All Slices | Content/Rules for all slices | |||
  type | S | 1..1 | CodeableConcept | Type of coverage |
  coverage:drug-coverage | S | 1..* | BackboneElement | Coverage details |
  Slices for extension | S | 1..* | Extension | Extension Slice: Unordered, Open by value:url |
| usdf-FormularyReference-extension | S | 1..* | Reference(Formulary) | Formulary Reference URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension |
 type | 1..1 | CodeableConcept | Type of coverage Required Pattern: At least the following | |
  coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: DRUGPOL | |
 Slices for benefit | 1..* | BackboneElement | List of benefits Slice: Unordered, Open by pattern:type | |
| benefit:All Slices | Content/Rules for all slices | |||
| type | 1..1 | CodeableConcept | Type of benefit Binding: Insurance plan type (extensible) | |
| benefit:drug-plan | S | 1..* | BackboneElement | List of benefits |
| type | 1..1 | CodeableConcept | Type of benefit Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |
| display | 1..1 | string | Representation defined by the system Fixed Value: Drug | |
| Slices for plan | S | 1..* | BackboneElement | Plan details Slice: Unordered, Open by pattern:type |
| plan:All Slices | Content/Rules for all slices | |||
| type | 0..1 | CodeableConcept | Type of plan Binding: Insurance plan type (extensible) | |
| plan:drug-plan | S | 1..* | BackboneElement | Drug plan |
| type | 1..1 | CodeableConcept | Type of plan Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |
| display | 1..1 | string | Representation defined by the system Fixed Value: Drug | |
| network | 0..* | Reference(Organization) | Pharmacy benefit types that are part of the drug plan | |
| specificCost | S | 1..* | BackboneElement | Pharmacy benefit type specific cost |
| category | S | 1..1 | CodeableConcept | Pharmacy Benefit Type Binding: Pharmacy benefit types (extensible) |
| benefit | S | 1..* | BackboneElement | Drug tier benefit |
| type | S | 1..1 | CodeableConcept | Type of specific benefit Binding: Drug tier of medication in health plan (extensible) |
| Slices for cost | S | 1..* | BackboneElement | List of the costs Slice: Unordered, Open by pattern:type |
| cost:All Slices | Content/Rules for all slices | |||
 type | 1..1 | CodeableConcept | Type of cost Binding: Benefit type of cost (extensible) | |
| qualifiers | S | 1..1 | CodeableConcept | Additional information about the cost |
| value | S | 0..1 | Quantity | The actual cost value |
| cost:copay | S | 0..1 | BackboneElement | Copay costs |
| type | 1..1 | CodeableConcept | Type of cost Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: copay | |
| qualifiers | 0..* | CodeableConcept | Additional information about the cost Binding: Qualifier of copay amount (required) | |
 value | 0..1 | MoneyQuantity | An amount of money. With regard to precision, see [Decimal Precision](datatypes.html#precision) | |
| value | S | 1..1 | decimal | Numerical value (with implicit precision) |
| system | 0..1 | uri | System that defines coded unit form Required Pattern: urn:iso:std:iso:4217 | |
| code | 0..1 | code | Coded form of the unit Required Pattern: USD | |
| cost:coinsurance | S | 0..1 | BackboneElement | Coinsurance costs |
| type | 1..1 | CodeableConcept | Type of cost Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: coinsurance | |
| qualifiers | 0..* | CodeableConcept | Additional information about the cost Binding: Qualifier for coinsurance rate (required) | |
| value | ||||
| system | 0..1 | uri | System that defines coded unit form Required Pattern: http://unitsofmeasure.org | |
| code | 0..1 | code | Coded form of the unit Required Pattern: % | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet |
| InsurancePlan.type | extensible | InsuranceProductTypeVS |
| InsurancePlan.contact.purpose | extensible | PlanContactTypeVS |
| InsurancePlan.coverage:drug-coverage.benefit.type | extensible | InsurancePlanType |
| InsurancePlan.plan.type | extensible | InsurancePlanType |
| InsurancePlan.plan:drug-plan.specificCost.category | extensible | PharmacyBenefitTypeVS (a valid code from Codes for pharmacy benefit types) |
| InsurancePlan.plan:drug-plan.specificCost.benefit.type | extensible | DrugTierVS (a valid code from Codes for medication drug tiers in health plans) |
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost.type | extensible | BenefitCostTypeVS (a valid code from Codes for benefit type of cost) |
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.qualifiers | required | CopayOptionVS |
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.qualifiers | required | CoinsuranceOptionVS |
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| InsurancePlan | C | 0..* | InsurancePlan | Details of a Health Insurance product/plan provided by an organization |
| meta | Σ | 0..1 | Meta | Metadata about the resource |
 lastUpdated | SΣ | 1..1 | instant | When the resource version last changed |
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
 modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| identifier | SΣC | 1..* | Identifier | Business Identifier for Product |
| status | ?!SΣ | 1..1 | code | draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. |
| type | SΣ | 1..1 | CodeableConcept | Product type Binding: Insurance Product Type VS (extensible) |
| name | SΣC | 0..1 | string | Official name |
| period | S | 0..1 | Period | When the product is available |
| coverageArea | SΣ | 0..* | Reference(Insurance Plan Location) | Where product applies |
| contact | 0..* | BackboneElement | Contact information for the Insurance Plan including URLs for brochure and formulary information | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| purpose | 0..1 | CodeableConcept | The type of contact Binding: Type of plan contact (extensible) | |
| name | S | 0..1 | HumanName | A name associated with the contact |
| use | ?!Σ | 0..1 | code | usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name. |
| text | SΣ | 0..1 | string | Text representation of the full name |
| telecom | S | 0..* | ContactPoint | Contact details (telephone, email, etc.) for a contact |
| system | SΣC | 0..1 | code | phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point. |
| value | SΣ | 0..1 | string | The actual contact point details |
| use | ?!Σ | 0..1 | code | home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required): Use of contact point. |
| Slices for coverage | S | 1..* | BackboneElement | Coverage details Slice: Unordered, Open by pattern:type |
| coverage:All Slices | Content/Rules for all slices | |||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | S | 1..1 | CodeableConcept | Type of coverage |
| benefit | 1..* | BackboneElement | List of benefits | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of benefit | |
| coverage:drug-coverage | S | 1..* | BackboneElement | Coverage details |
| Slices for extension | S | 1..* | Extension | Extension Slice: Unordered, Open by value:url |
| usdf-FormularyReference-extension | S | 1..* | Reference(Formulary) | Formulary Reference URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of coverage Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: DRUGPOL | |
| Slices for benefit | 1..* | BackboneElement | List of benefits Slice: Unordered, Open by pattern:type | |
| benefit:All Slices | Content/Rules for all slices | |||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of benefit Binding: Insurance plan type (extensible) | |
| benefit:drug-plan | S | 1..* | BackboneElement | List of benefits |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of benefit Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |
| display | 1..1 | string | Representation defined by the system Fixed Value: Drug | |
| Slices for plan | S | 1..* | BackboneElement | Plan details Slice: Unordered, Open by pattern:type |
| plan:All Slices | Content/Rules for all slices | |||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 0..1 | CodeableConcept | Type of plan Binding: Insurance plan type (extensible) | |
| plan:drug-plan | S | 1..* | BackboneElement | Drug plan |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of plan Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |
| display | 1..1 | string | Representation defined by the system Fixed Value: Drug | |
| network | 0..* | Reference(Organization) | Pharmacy benefit types that are part of the drug plan | |
| specificCost | S | 1..* | BackboneElement | Pharmacy benefit type specific cost |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| category | S | 1..1 | CodeableConcept | Pharmacy Benefit Type Binding: Pharmacy benefit types (extensible) |
| benefit | S | 1..* | BackboneElement | Drug tier benefit |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | S | 1..1 | CodeableConcept | Type of specific benefit Binding: Drug tier of medication in health plan (extensible) |
| Slices for cost | S | 1..* | BackboneElement | List of the costs Slice: Unordered, Open by pattern:type |
| cost:All Slices | Content/Rules for all slices | |||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of cost Binding: Benefit type of cost (extensible) | |
| qualifiers | S | 1..1 | CodeableConcept | Additional information about the cost |
| value | S | 0..1 | Quantity | The actual cost value |
| cost:copay | S | 0..1 | BackboneElement | Copay costs |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of cost Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: copay | |
| qualifiers | 0..* | CodeableConcept | Additional information about the cost Binding: Qualifier of copay amount (required) | |
| value | C | 0..1 | MoneyQuantity | An amount of money. With regard to precision, see [Decimal Precision](datatypes.html#precision) |
| value | SΣ | 1..1 | decimal | Numerical value (with implicit precision) |
| comparator | ?!Σ | 0..1 | code | < | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented. |
| system | ΣC | 0..1 | uri | System that defines coded unit form Required Pattern: urn:iso:std:iso:4217 |
| code | Σ | 0..1 | code | Coded form of the unit Required Pattern: USD |
| cost:coinsurance | S | 0..1 | BackboneElement | Coinsurance costs |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of cost Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: coinsurance | |
 qualifiers | 0..* | CodeableConcept | Additional information about the cost Binding: Qualifier for coinsurance rate (required) | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet |
| InsurancePlan.status | required | PublicationStatus |
| InsurancePlan.type | extensible | InsuranceProductTypeVS |
| InsurancePlan.contact.purpose | extensible | PlanContactTypeVS |
| InsurancePlan.contact.name.use | required | NameUse |
| InsurancePlan.contact.telecom.system | required | ContactPointSystem |
| InsurancePlan.contact.telecom.use | required | ContactPointUse |
| InsurancePlan.coverage:drug-coverage.benefit.type | extensible | InsurancePlanType |
| InsurancePlan.plan.type | extensible | InsurancePlanType |
| InsurancePlan.plan:drug-plan.specificCost.category | extensible | PharmacyBenefitTypeVS (a valid code from Codes for pharmacy benefit types) |
| InsurancePlan.plan:drug-plan.specificCost.benefit.type | extensible | DrugTierVS (a valid code from Codes for medication drug tiers in health plans) |
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost.type | extensible | BenefitCostTypeVS (a valid code from Codes for benefit type of cost) |
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.qualifiers | required | CopayOptionVS |
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.comparator | required | QuantityComparator |
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.qualifiers | required | CoinsuranceOptionVS |
| Name | Flags | Card. | Type | Description & Constraints | ||||
|---|---|---|---|---|---|---|---|---|
| InsurancePlan | C | 0..* | InsurancePlan | Details of a Health Insurance product/plan provided by an organization | ||||
| id | Σ | 0..1 | id | Logical id of this artifact | ||||
| meta | Σ | 0..1 | Meta | Metadata about the resource | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| versionId | Σ | 0..1 | id | Version specific identifier | ||||
| lastUpdated | SΣ | 1..1 | instant | When the resource version last changed | ||||
| source | Σ | 0..1 | uri | Identifies where the resource comes from | ||||
| profile | Σ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to | ||||
| security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | ||||
| tag | Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | ||||
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
| contained | 0..* | Resource | Contained, inline Resources | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier | SΣC | 1..* | Identifier | Business Identifier for Product | ||||
| status | ?!SΣ | 1..1 | code | draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. | ||||
| type | SΣ | 1..1 | CodeableConcept | Product type Binding: Insurance Product Type VS (extensible) | ||||
| name | SΣC | 0..1 | string | Official name | ||||
| alias | 0..* | string | Alternate names | |||||
| period | S | 0..1 | Period | When the product is available | ||||
| ownedBy | Σ | 0..1 | Reference(Organization) | Plan issuer | ||||
| administeredBy | Σ | 0..1 | Reference(Organization) | Product administrator | ||||
| coverageArea | SΣ | 0..* | Reference(Insurance Plan Location) | Where product applies | ||||
| contact | 0..* | BackboneElement | Contact information for the Insurance Plan including URLs for brochure and formulary information | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| purpose | 0..1 | CodeableConcept | The type of contact Binding: Type of plan contact (extensible) | |||||
| name | S | 0..1 | HumanName | A name associated with the contact | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| use | ?!Σ | 0..1 | code | usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name. | ||||
| text | SΣ | 0..1 | string | Text representation of the full name | ||||
| family | Σ | 0..1 | string | Family name (often called 'Surname') | ||||
| given | Σ | 0..* | string | Given names (not always 'first'). Includes middle names This repeating element order: Given Names appear in the correct order for presenting the name | ||||
| prefix | Σ | 0..* | string | Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name | ||||
| suffix | Σ | 0..* | string | Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name | ||||
| period | Σ | 0..1 | Period | Time period when name was/is in use | ||||
| telecom | S | 0..* | ContactPoint | Contact details (telephone, email, etc.) for a contact | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| system | SΣC | 0..1 | code | phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point. | ||||
| value | SΣ | 0..1 | string | The actual contact point details | ||||
| use | ?!Σ | 0..1 | code | home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required): Use of contact point. | ||||
| rank | Σ | 0..1 | positiveInt | Specify preferred order of use (1 = highest) | ||||
| period | Σ | 0..1 | Period | Time period when the contact point was/is in use | ||||
| address | 0..1 | Address | Visiting or postal addresses for the contact | |||||
| endpoint | 0..* | Reference(Endpoint) | Technical endpoint | |||||
| network | 0..* | Reference(Organization) | What networks are Included | |||||
| Slices for coverage | S | 1..* | BackboneElement | Coverage details Slice: Unordered, Open by pattern:type | ||||
| coverage:All Slices | Content/Rules for all slices | |||||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | S | 1..1 | CodeableConcept | Type of coverage | ||||
| network | 0..* | Reference(Organization) | What networks provide coverage | |||||
| benefit | 1..* | BackboneElement | List of benefits | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of benefit | |||||
| requirement | 0..1 | string | Referral requirements | |||||
| limit | 0..* | BackboneElement | Benefit limits | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| value | 0..1 | Quantity | Maximum value allowed | |||||
| code | 0..1 | CodeableConcept | Benefit limit details | |||||
| coverage:drug-coverage | S | 1..* | BackboneElement | Coverage details | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension | S | 1..* | Extension | Extension Slice: Unordered, Open by value:url | ||||
| usdf-FormularyReference-extension | S | 1..* | Reference(Formulary) | Formulary Reference URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension | ||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of coverage Required Pattern: At least the following | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode | |||||
| version | 0..1 | string | Version of the system - if relevant | |||||
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: DRUGPOL | |||||
| display | 0..1 | string | Representation defined by the system | |||||
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
| text | 0..1 | string | Plain text representation of the concept | |||||
| network | 0..* | Reference(Organization) | What networks provide coverage | |||||
| Slices for benefit | 1..* | BackboneElement | List of benefits Slice: Unordered, Open by pattern:type | |||||
| benefit:All Slices | Content/Rules for all slices | |||||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of benefit Binding: Insurance plan type (extensible) | |||||
| requirement | 0..1 | string | Referral requirements | |||||
| limit | 0..* | BackboneElement | Benefit limits | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| value | 0..1 | Quantity | Maximum value allowed | |||||
| code | 0..1 | CodeableConcept | Benefit limit details | |||||
| benefit:drug-plan | S | 1..* | BackboneElement | List of benefits | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of benefit Required Pattern: At least the following | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type | |||||
| version | 0..1 | string | Version of the system - if relevant | |||||
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |||||
| display | 1..1 | string | Representation defined by the system Fixed Value: Drug | |||||
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
| text | 0..1 | string | Plain text representation of the concept | |||||
| requirement | 0..1 | string | Referral requirements | |||||
| limit | 0..* | BackboneElement | Benefit limits | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| value | 0..1 | Quantity | Maximum value allowed | |||||
| code | 0..1 | CodeableConcept | Benefit limit details | |||||
| Slices for plan | S | 1..* | BackboneElement | Plan details Slice: Unordered, Open by pattern:type | ||||
| plan:All Slices | Content/Rules for all slices | |||||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| identifier | Σ | 0..* | Identifier | Business Identifier for Product | ||||
| type | 0..1 | CodeableConcept | Type of plan Binding: Insurance plan type (extensible) | |||||
| coverageArea | Σ | 0..* | Reference(Location) | Where product applies | ||||
| network | 0..* | Reference(Organization) | What networks provide coverage | |||||
| generalCost | 0..* | BackboneElement | Overall costs | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 0..1 | CodeableConcept | Type of cost | |||||
| groupSize | 0..1 | positiveInt | Number of enrollees | |||||
| cost | 0..1 | Money | Cost value | |||||
| comment | 0..1 | string | Additional cost information | |||||
| specificCost | 0..* | BackboneElement | Specific costs | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| category | 1..1 | CodeableConcept | General category of benefit | |||||
| benefit | 0..* | BackboneElement | Benefits list | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of specific benefit | |||||
| cost | 0..* | BackboneElement | List of the costs | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of cost | |||||
| applicability | 0..1 | CodeableConcept | in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers. | |||||
| qualifiers | 0..* | CodeableConcept | Additional information about the cost | |||||
| value | 0..1 | Quantity | The actual cost value | |||||
| plan:drug-plan | S | 1..* | BackboneElement | Drug plan | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| identifier | Σ | 0..* | Identifier | Business Identifier for Product | ||||
| type | 1..1 | CodeableConcept | Type of plan Required Pattern: At least the following | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type | |||||
| version | 0..1 | string | Version of the system - if relevant | |||||
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |||||
| display | 1..1 | string | Representation defined by the system Fixed Value: Drug | |||||
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
| text | 0..1 | string | Plain text representation of the concept | |||||
| coverageArea | Σ | 0..* | Reference(Location) | Where product applies | ||||
| network | 0..* | Reference(Organization) | Pharmacy benefit types that are part of the drug plan | |||||
| generalCost | 0..* | BackboneElement | Overall costs | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 0..1 | CodeableConcept | Type of cost | |||||
| groupSize | 0..1 | positiveInt | Number of enrollees | |||||
| cost | 0..1 | Money | Cost value | |||||
| comment | 0..1 | string | Additional cost information | |||||
| specificCost | S | 1..* | BackboneElement | Pharmacy benefit type specific cost | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| category | S | 1..1 | CodeableConcept | Pharmacy Benefit Type Binding: Pharmacy benefit types (extensible) | ||||
| benefit | S | 1..* | BackboneElement | Drug tier benefit | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | S | 1..1 | CodeableConcept | Type of specific benefit Binding: Drug tier of medication in health plan (extensible) | ||||
| Slices for cost | S | 1..* | BackboneElement | List of the costs Slice: Unordered, Open by pattern:type | ||||
| cost:All Slices | Content/Rules for all slices | |||||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of cost Binding: Benefit type of cost (extensible) | |||||
| applicability | 0..1 | CodeableConcept | in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers. | |||||
| qualifiers | S | 1..1 | CodeableConcept | Additional information about the cost | ||||
| value | S | 0..1 | Quantity | The actual cost value | ||||
| cost:copay | S | 0..1 | BackboneElement | Copay costs | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of cost Required Pattern: At least the following | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE | |||||
| version | 0..1 | string | Version of the system - if relevant | |||||
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: copay | |||||
| display | 0..1 | string | Representation defined by the system | |||||
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
| text | 0..1 | string | Plain text representation of the concept | |||||
| applicability | 0..1 | CodeableConcept | in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers. | |||||
| qualifiers | 0..* | CodeableConcept | Additional information about the cost Binding: Qualifier of copay amount (required) | |||||
| value | C | 0..1 | MoneyQuantity | An amount of money. With regard to precision, see [Decimal Precision](datatypes.html#precision) | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| value | SΣ | 1..1 | decimal | Numerical value (with implicit precision) | ||||
| comparator | ?!Σ | 0..1 | code | < | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented. | ||||
| unit | Σ | 0..1 | string | Unit representation | ||||
| system | ΣC | 0..1 | uri | System that defines coded unit form Required Pattern: urn:iso:std:iso:4217 | ||||
| code | Σ | 0..1 | code | Coded form of the unit Required Pattern: USD | ||||
| cost:coinsurance | S | 0..1 | BackboneElement | Coinsurance costs | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of cost Required Pattern: At least the following | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE | |||||
| version | 0..1 | string | Version of the system - if relevant | |||||
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: coinsurance | |||||
| display | 0..1 | string | Representation defined by the system | |||||
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
| text | 0..1 | string | Plain text representation of the concept | |||||
| applicability | 0..1 | CodeableConcept | in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers. | |||||
| qualifiers | 0..* | CodeableConcept | Additional information about the cost Binding: Qualifier for coinsurance rate (required) | |||||
| value | 0..1 | Quantity | The actual cost value | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| value | Σ | 0..1 | decimal | Numerical value (with implicit precision) | ||||
| comparator | ?!Σ | 0..1 | code | < | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented. | ||||
| unit | Σ | 0..1 | string | Unit representation | ||||
| system | ΣC | 0..1 | uri | System that defines coded unit form Required Pattern: http://unitsofmeasure.org | ||||
| code | Σ | 0..1 | code | Coded form of the unit Required Pattern: % | ||||
| Documentation for this format | ||||||||
| Path | Conformance | ValueSet | ||||
| InsurancePlan.meta.security | extensible | All Security Labels | ||||
| InsurancePlan.meta.tag | example | CommonTags | ||||
| InsurancePlan.language | preferred | CommonLanguages
| ||||
| InsurancePlan.status | required | PublicationStatus | ||||
| InsurancePlan.type | extensible | InsuranceProductTypeVS | ||||
| InsurancePlan.contact.purpose | extensible | PlanContactTypeVS | ||||
| InsurancePlan.contact.name.use | required | NameUse | ||||
| InsurancePlan.contact.telecom.system | required | ContactPointSystem | ||||
| InsurancePlan.contact.telecom.use | required | ContactPointUse | ||||
| InsurancePlan.coverage:drug-coverage.benefit.type | extensible | InsurancePlanType | ||||
| InsurancePlan.plan.type | extensible | InsurancePlanType | ||||
| InsurancePlan.plan.specificCost.benefit.cost.applicability | required | BenefitCostApplicability | ||||
| InsurancePlan.plan:drug-plan.specificCost.category | extensible | PharmacyBenefitTypeVS (a valid code from Codes for pharmacy benefit types) | ||||
| InsurancePlan.plan:drug-plan.specificCost.benefit.type | extensible | DrugTierVS (a valid code from Codes for medication drug tiers in health plans) | ||||
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost.type | extensible | BenefitCostTypeVS (a valid code from Codes for benefit type of cost) | ||||
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost.applicability | required | BenefitCostApplicability | ||||
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.applicability | required | BenefitCostApplicability | ||||
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.qualifiers | required | CopayOptionVS | ||||
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.comparator | required | QuantityComparator | ||||
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.applicability | required | BenefitCostApplicability | ||||
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.qualifiers | required | CoinsuranceOptionVS | ||||
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value.comparator | required | QuantityComparator |
This structure is derived from InsurancePlan
Summary
Mandatory: 15 elements (2 nested mandatory elements)
Must-Support: 30 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Slices
This structure defines the following Slices:
Differential View
This structure is derived from InsurancePlan
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| InsurancePlan | 0..* | InsurancePlan | Details of a Health Insurance product/plan provided by an organization | |
| meta | ||||
| lastUpdated | S | 1..1 | instant | When the resource version last changed |
| identifier | S | 1..* | Identifier | Business Identifier for Product |
| status | S | 1..1 | code | draft | active | retired | unknown |
| type | S | 1..1 | CodeableConcept | Product type Binding: Insurance Product Type VS (extensible) |
| name | S | 0..1 | string | Official name |
| period | S | 0..1 | Period | When the product is available |
| coverageArea | S | 0..* | Reference(Insurance Plan Location) | Where product applies |
| contact | 0..* | BackboneElement | Contact information for the Insurance Plan including URLs for brochure and formulary information | |
| purpose | 0..1 | CodeableConcept | The type of contact Binding: Type of plan contact (extensible) | |
| name | S | 0..1 | HumanName | A name associated with the contact |
| text | S | 0..1 | string | Text representation of the full name |
| telecom | S | 0..* | ContactPoint | Contact details (telephone, email, etc.) for a contact |
| system | S | 0..1 | code | phone | fax | email | pager | url | sms | other |
| value | S | 0..1 | string | The actual contact point details |
| Slices for coverage | S | 1..* | BackboneElement | Coverage details Slice: Unordered, Open by pattern:type |
| coverage:All Slices | Content/Rules for all slices | |||
| type | S | 1..1 | CodeableConcept | Type of coverage |
| coverage:drug-coverage | S | 1..* | BackboneElement | Coverage details |
| Slices for extension | S | 1..* | Extension | Extension Slice: Unordered, Open by value:url |
| usdf-FormularyReference-extension | S | 1..* | Reference(Formulary) | Formulary Reference URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension |
| type | 1..1 | CodeableConcept | Type of coverage Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: DRUGPOL | |
| Slices for benefit | 1..* | BackboneElement | List of benefits Slice: Unordered, Open by pattern:type | |
| benefit:All Slices | Content/Rules for all slices | |||
| type | 1..1 | CodeableConcept | Type of benefit Binding: Insurance plan type (extensible) | |
| benefit:drug-plan | S | 1..* | BackboneElement | List of benefits |
| type | 1..1 | CodeableConcept | Type of benefit Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |
| display | 1..1 | string | Representation defined by the system Fixed Value: Drug | |
| Slices for plan | S | 1..* | BackboneElement | Plan details Slice: Unordered, Open by pattern:type |
| plan:All Slices | Content/Rules for all slices | |||
| type | 0..1 | CodeableConcept | Type of plan Binding: Insurance plan type (extensible) | |
| plan:drug-plan | S | 1..* | BackboneElement | Drug plan |
| type | 1..1 | CodeableConcept | Type of plan Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |
| display | 1..1 | string | Representation defined by the system Fixed Value: Drug | |
| network | 0..* | Reference(Organization) | Pharmacy benefit types that are part of the drug plan | |
| specificCost | S | 1..* | BackboneElement | Pharmacy benefit type specific cost |
| category | S | 1..1 | CodeableConcept | Pharmacy Benefit Type Binding: Pharmacy benefit types (extensible) |
| benefit | S | 1..* | BackboneElement | Drug tier benefit |
| type | S | 1..1 | CodeableConcept | Type of specific benefit Binding: Drug tier of medication in health plan (extensible) |
| Slices for cost | S | 1..* | BackboneElement | List of the costs Slice: Unordered, Open by pattern:type |
| cost:All Slices | Content/Rules for all slices | |||
| type | 1..1 | CodeableConcept | Type of cost Binding: Benefit type of cost (extensible) | |
| qualifiers | S | 1..1 | CodeableConcept | Additional information about the cost |
| value | S | 0..1 | Quantity | The actual cost value |
| cost:copay | S | 0..1 | BackboneElement | Copay costs |
| type | 1..1 | CodeableConcept | Type of cost Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: copay | |
| qualifiers | 0..* | CodeableConcept | Additional information about the cost Binding: Qualifier of copay amount (required) | |
| value | 0..1 | MoneyQuantity | An amount of money. With regard to precision, see [Decimal Precision](datatypes.html#precision) | |
| value | S | 1..1 | decimal | Numerical value (with implicit precision) |
| system | 0..1 | uri | System that defines coded unit form Required Pattern: urn:iso:std:iso:4217 | |
| code | 0..1 | code | Coded form of the unit Required Pattern: USD | |
| cost:coinsurance | S | 0..1 | BackboneElement | Coinsurance costs |
| type | 1..1 | CodeableConcept | Type of cost Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: coinsurance | |
| qualifiers | 0..* | CodeableConcept | Additional information about the cost Binding: Qualifier for coinsurance rate (required) | |
| value | ||||
| system | 0..1 | uri | System that defines coded unit form Required Pattern: http://unitsofmeasure.org | |
| code | 0..1 | code | Coded form of the unit Required Pattern: % | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet |
| InsurancePlan.type | extensible | InsuranceProductTypeVS |
| InsurancePlan.contact.purpose | extensible | PlanContactTypeVS |
| InsurancePlan.coverage:drug-coverage.benefit.type | extensible | InsurancePlanType |
| InsurancePlan.plan.type | extensible | InsurancePlanType |
| InsurancePlan.plan:drug-plan.specificCost.category | extensible | PharmacyBenefitTypeVS (a valid code from Codes for pharmacy benefit types) |
| InsurancePlan.plan:drug-plan.specificCost.benefit.type | extensible | DrugTierVS (a valid code from Codes for medication drug tiers in health plans) |
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost.type | extensible | BenefitCostTypeVS (a valid code from Codes for benefit type of cost) |
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.qualifiers | required | CopayOptionVS |
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.qualifiers | required | CoinsuranceOptionVS |
Key Elements View
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| InsurancePlan | C | 0..* | InsurancePlan | Details of a Health Insurance product/plan provided by an organization |
| meta | Σ | 0..1 | Meta | Metadata about the resource |
| lastUpdated | SΣ | 1..1 | instant | When the resource version last changed |
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created |
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored |
| identifier | SΣC | 1..* | Identifier | Business Identifier for Product |
| status | ?!SΣ | 1..1 | code | draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. |
| type | SΣ | 1..1 | CodeableConcept | Product type Binding: Insurance Product Type VS (extensible) |
| name | SΣC | 0..1 | string | Official name |
| period | S | 0..1 | Period | When the product is available |
| coverageArea | SΣ | 0..* | Reference(Insurance Plan Location) | Where product applies |
| contact | 0..* | BackboneElement | Contact information for the Insurance Plan including URLs for brochure and formulary information | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| purpose | 0..1 | CodeableConcept | The type of contact Binding: Type of plan contact (extensible) | |
| name | S | 0..1 | HumanName | A name associated with the contact |
| use | ?!Σ | 0..1 | code | usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name. |
| text | SΣ | 0..1 | string | Text representation of the full name |
| telecom | S | 0..* | ContactPoint | Contact details (telephone, email, etc.) for a contact |
| system | SΣC | 0..1 | code | phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point. |
| value | SΣ | 0..1 | string | The actual contact point details |
| use | ?!Σ | 0..1 | code | home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required): Use of contact point. |
| Slices for coverage | S | 1..* | BackboneElement | Coverage details Slice: Unordered, Open by pattern:type |
| coverage:All Slices | Content/Rules for all slices | |||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | S | 1..1 | CodeableConcept | Type of coverage |
| benefit | 1..* | BackboneElement | List of benefits | |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of benefit | |
| coverage:drug-coverage | S | 1..* | BackboneElement | Coverage details |
| Slices for extension | S | 1..* | Extension | Extension Slice: Unordered, Open by value:url |
| usdf-FormularyReference-extension | S | 1..* | Reference(Formulary) | Formulary Reference URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of coverage Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: DRUGPOL | |
| Slices for benefit | 1..* | BackboneElement | List of benefits Slice: Unordered, Open by pattern:type | |
| benefit:All Slices | Content/Rules for all slices | |||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of benefit Binding: Insurance plan type (extensible) | |
| benefit:drug-plan | S | 1..* | BackboneElement | List of benefits |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of benefit Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |
| display | 1..1 | string | Representation defined by the system Fixed Value: Drug | |
| Slices for plan | S | 1..* | BackboneElement | Plan details Slice: Unordered, Open by pattern:type |
| plan:All Slices | Content/Rules for all slices | |||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 0..1 | CodeableConcept | Type of plan Binding: Insurance plan type (extensible) | |
| plan:drug-plan | S | 1..* | BackboneElement | Drug plan |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of plan Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |
| display | 1..1 | string | Representation defined by the system Fixed Value: Drug | |
| network | 0..* | Reference(Organization) | Pharmacy benefit types that are part of the drug plan | |
| specificCost | S | 1..* | BackboneElement | Pharmacy benefit type specific cost |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| category | S | 1..1 | CodeableConcept | Pharmacy Benefit Type Binding: Pharmacy benefit types (extensible) |
| benefit | S | 1..* | BackboneElement | Drug tier benefit |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | S | 1..1 | CodeableConcept | Type of specific benefit Binding: Drug tier of medication in health plan (extensible) |
| Slices for cost | S | 1..* | BackboneElement | List of the costs Slice: Unordered, Open by pattern:type |
| cost:All Slices | Content/Rules for all slices | |||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of cost Binding: Benefit type of cost (extensible) | |
| qualifiers | S | 1..1 | CodeableConcept | Additional information about the cost |
| value | S | 0..1 | Quantity | The actual cost value |
| cost:copay | S | 0..1 | BackboneElement | Copay costs |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of cost Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: copay | |
| qualifiers | 0..* | CodeableConcept | Additional information about the cost Binding: Qualifier of copay amount (required) | |
| value | C | 0..1 | MoneyQuantity | An amount of money. With regard to precision, see [Decimal Precision](datatypes.html#precision) |
| value | SΣ | 1..1 | decimal | Numerical value (with implicit precision) |
| comparator | ?!Σ | 0..1 | code | < | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented. |
| system | ΣC | 0..1 | uri | System that defines coded unit form Required Pattern: urn:iso:std:iso:4217 |
| code | Σ | 0..1 | code | Coded form of the unit Required Pattern: USD |
| cost:coinsurance | S | 0..1 | BackboneElement | Coinsurance costs |
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized |
| type | 1..1 | CodeableConcept | Type of cost Required Pattern: At least the following | |
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE | |
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: coinsurance | |
| qualifiers | 0..* | CodeableConcept | Additional information about the cost Binding: Qualifier for coinsurance rate (required) | |
| Documentation for this format | ||||
| Path | Conformance | ValueSet |
| InsurancePlan.status | required | PublicationStatus |
| InsurancePlan.type | extensible | InsuranceProductTypeVS |
| InsurancePlan.contact.purpose | extensible | PlanContactTypeVS |
| InsurancePlan.contact.name.use | required | NameUse |
| InsurancePlan.contact.telecom.system | required | ContactPointSystem |
| InsurancePlan.contact.telecom.use | required | ContactPointUse |
| InsurancePlan.coverage:drug-coverage.benefit.type | extensible | InsurancePlanType |
| InsurancePlan.plan.type | extensible | InsurancePlanType |
| InsurancePlan.plan:drug-plan.specificCost.category | extensible | PharmacyBenefitTypeVS (a valid code from Codes for pharmacy benefit types) |
| InsurancePlan.plan:drug-plan.specificCost.benefit.type | extensible | DrugTierVS (a valid code from Codes for medication drug tiers in health plans) |
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost.type | extensible | BenefitCostTypeVS (a valid code from Codes for benefit type of cost) |
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.qualifiers | required | CopayOptionVS |
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.comparator | required | QuantityComparator |
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.qualifiers | required | CoinsuranceOptionVS |
Snapshot View
| Name | Flags | Card. | Type | Description & Constraints | ||||
|---|---|---|---|---|---|---|---|---|
| InsurancePlan | C | 0..* | InsurancePlan | Details of a Health Insurance product/plan provided by an organization | ||||
| id | Σ | 0..1 | id | Logical id of this artifact | ||||
| meta | Σ | 0..1 | Meta | Metadata about the resource | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| versionId | Σ | 0..1 | id | Version specific identifier | ||||
| lastUpdated | SΣ | 1..1 | instant | When the resource version last changed | ||||
| source | Σ | 0..1 | uri | Identifies where the resource comes from | ||||
| profile | Σ | 0..* | canonical(StructureDefinition) | Profiles this resource claims to conform to | ||||
| security | Σ | 0..* | Coding | Security Labels applied to this resource Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System. | ||||
| tag | Σ | 0..* | Coding | Tags applied to this resource Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones". | ||||
| implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
| language | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
| text | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
| contained | 0..* | Resource | Contained, inline Resources | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
| identifier | SΣC | 1..* | Identifier | Business Identifier for Product | ||||
| status | ?!SΣ | 1..1 | code | draft | active | retired | unknown Binding: PublicationStatus (required): The lifecycle status of an artifact. | ||||
| type | SΣ | 1..1 | CodeableConcept | Product type Binding: Insurance Product Type VS (extensible) | ||||
| name | SΣC | 0..1 | string | Official name | ||||
| alias | 0..* | string | Alternate names | |||||
| period | S | 0..1 | Period | When the product is available | ||||
| ownedBy | Σ | 0..1 | Reference(Organization) | Plan issuer | ||||
| administeredBy | Σ | 0..1 | Reference(Organization) | Product administrator | ||||
| coverageArea | SΣ | 0..* | Reference(Insurance Plan Location) | Where product applies | ||||
| contact | 0..* | BackboneElement | Contact information for the Insurance Plan including URLs for brochure and formulary information | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| purpose | 0..1 | CodeableConcept | The type of contact Binding: Type of plan contact (extensible) | |||||
| name | S | 0..1 | HumanName | A name associated with the contact | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| use | ?!Σ | 0..1 | code | usual | official | temp | nickname | anonymous | old | maiden Binding: NameUse (required): The use of a human name. | ||||
| text | SΣ | 0..1 | string | Text representation of the full name | ||||
| family | Σ | 0..1 | string | Family name (often called 'Surname') | ||||
| given | Σ | 0..* | string | Given names (not always 'first'). Includes middle names This repeating element order: Given Names appear in the correct order for presenting the name | ||||
| prefix | Σ | 0..* | string | Parts that come before the name This repeating element order: Prefixes appear in the correct order for presenting the name | ||||
| suffix | Σ | 0..* | string | Parts that come after the name This repeating element order: Suffixes appear in the correct order for presenting the name | ||||
| period | Σ | 0..1 | Period | Time period when name was/is in use | ||||
| telecom | S | 0..* | ContactPoint | Contact details (telephone, email, etc.) for a contact | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| system | SΣC | 0..1 | code | phone | fax | email | pager | url | sms | other Binding: ContactPointSystem (required): Telecommunications form for contact point. | ||||
| value | SΣ | 0..1 | string | The actual contact point details | ||||
| use | ?!Σ | 0..1 | code | home | work | temp | old | mobile - purpose of this contact point Binding: ContactPointUse (required): Use of contact point. | ||||
| rank | Σ | 0..1 | positiveInt | Specify preferred order of use (1 = highest) | ||||
| period | Σ | 0..1 | Period | Time period when the contact point was/is in use | ||||
| address | 0..1 | Address | Visiting or postal addresses for the contact | |||||
| endpoint | 0..* | Reference(Endpoint) | Technical endpoint | |||||
| network | 0..* | Reference(Organization) | What networks are Included | |||||
| Slices for coverage | S | 1..* | BackboneElement | Coverage details Slice: Unordered, Open by pattern:type | ||||
| coverage:All Slices | Content/Rules for all slices | |||||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | S | 1..1 | CodeableConcept | Type of coverage | ||||
| network | 0..* | Reference(Organization) | What networks provide coverage | |||||
| benefit | 1..* | BackboneElement | List of benefits | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of benefit | |||||
| requirement | 0..1 | string | Referral requirements | |||||
| limit | 0..* | BackboneElement | Benefit limits | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| value | 0..1 | Quantity | Maximum value allowed | |||||
| code | 0..1 | CodeableConcept | Benefit limit details | |||||
| coverage:drug-coverage | S | 1..* | BackboneElement | Coverage details | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| Slices for extension | S | 1..* | Extension | Extension Slice: Unordered, Open by value:url | ||||
| usdf-FormularyReference-extension | S | 1..* | Reference(Formulary) | Formulary Reference URL: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-FormularyReference-extension | ||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of coverage Required Pattern: At least the following | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/v3-ActCode | |||||
| version | 0..1 | string | Version of the system - if relevant | |||||
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: DRUGPOL | |||||
| display | 0..1 | string | Representation defined by the system | |||||
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
| text | 0..1 | string | Plain text representation of the concept | |||||
| network | 0..* | Reference(Organization) | What networks provide coverage | |||||
| Slices for benefit | 1..* | BackboneElement | List of benefits Slice: Unordered, Open by pattern:type | |||||
| benefit:All Slices | Content/Rules for all slices | |||||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of benefit Binding: Insurance plan type (extensible) | |||||
| requirement | 0..1 | string | Referral requirements | |||||
| limit | 0..* | BackboneElement | Benefit limits | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| value | 0..1 | Quantity | Maximum value allowed | |||||
| code | 0..1 | CodeableConcept | Benefit limit details | |||||
| benefit:drug-plan | S | 1..* | BackboneElement | List of benefits | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of benefit Required Pattern: At least the following | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type | |||||
| version | 0..1 | string | Version of the system - if relevant | |||||
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |||||
| display | 1..1 | string | Representation defined by the system Fixed Value: Drug | |||||
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
| text | 0..1 | string | Plain text representation of the concept | |||||
| requirement | 0..1 | string | Referral requirements | |||||
| limit | 0..* | BackboneElement | Benefit limits | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| value | 0..1 | Quantity | Maximum value allowed | |||||
| code | 0..1 | CodeableConcept | Benefit limit details | |||||
| Slices for plan | S | 1..* | BackboneElement | Plan details Slice: Unordered, Open by pattern:type | ||||
| plan:All Slices | Content/Rules for all slices | |||||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| identifier | Σ | 0..* | Identifier | Business Identifier for Product | ||||
| type | 0..1 | CodeableConcept | Type of plan Binding: Insurance plan type (extensible) | |||||
| coverageArea | Σ | 0..* | Reference(Location) | Where product applies | ||||
| network | 0..* | Reference(Organization) | What networks provide coverage | |||||
| generalCost | 0..* | BackboneElement | Overall costs | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 0..1 | CodeableConcept | Type of cost | |||||
| groupSize | 0..1 | positiveInt | Number of enrollees | |||||
| cost | 0..1 | Money | Cost value | |||||
| comment | 0..1 | string | Additional cost information | |||||
| specificCost | 0..* | BackboneElement | Specific costs | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| category | 1..1 | CodeableConcept | General category of benefit | |||||
| benefit | 0..* | BackboneElement | Benefits list | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of specific benefit | |||||
| cost | 0..* | BackboneElement | List of the costs | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of cost | |||||
| applicability | 0..1 | CodeableConcept | in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers. | |||||
| qualifiers | 0..* | CodeableConcept | Additional information about the cost | |||||
| value | 0..1 | Quantity | The actual cost value | |||||
| plan:drug-plan | S | 1..* | BackboneElement | Drug plan | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| identifier | Σ | 0..* | Identifier | Business Identifier for Product | ||||
| type | 1..1 | CodeableConcept | Type of plan Required Pattern: At least the following | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://terminology.hl7.org/CodeSystem/insurance-plan-type | |||||
| version | 0..1 | string | Version of the system - if relevant | |||||
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: drug | |||||
| display | 1..1 | string | Representation defined by the system Fixed Value: Drug | |||||
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
| text | 0..1 | string | Plain text representation of the concept | |||||
| coverageArea | Σ | 0..* | Reference(Location) | Where product applies | ||||
| network | 0..* | Reference(Organization) | Pharmacy benefit types that are part of the drug plan | |||||
| generalCost | 0..* | BackboneElement | Overall costs | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 0..1 | CodeableConcept | Type of cost | |||||
| groupSize | 0..1 | positiveInt | Number of enrollees | |||||
| cost | 0..1 | Money | Cost value | |||||
| comment | 0..1 | string | Additional cost information | |||||
| specificCost | S | 1..* | BackboneElement | Pharmacy benefit type specific cost | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| category | S | 1..1 | CodeableConcept | Pharmacy Benefit Type Binding: Pharmacy benefit types (extensible) | ||||
| benefit | S | 1..* | BackboneElement | Drug tier benefit | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | S | 1..1 | CodeableConcept | Type of specific benefit Binding: Drug tier of medication in health plan (extensible) | ||||
| Slices for cost | S | 1..* | BackboneElement | List of the costs Slice: Unordered, Open by pattern:type | ||||
| cost:All Slices | Content/Rules for all slices | |||||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of cost Binding: Benefit type of cost (extensible) | |||||
| applicability | 0..1 | CodeableConcept | in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers. | |||||
| qualifiers | S | 1..1 | CodeableConcept | Additional information about the cost | ||||
| value | S | 0..1 | Quantity | The actual cost value | ||||
| cost:copay | S | 0..1 | BackboneElement | Copay costs | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of cost Required Pattern: At least the following | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE | |||||
| version | 0..1 | string | Version of the system - if relevant | |||||
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: copay | |||||
| display | 0..1 | string | Representation defined by the system | |||||
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
| text | 0..1 | string | Plain text representation of the concept | |||||
| applicability | 0..1 | CodeableConcept | in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers. | |||||
| qualifiers | 0..* | CodeableConcept | Additional information about the cost Binding: Qualifier of copay amount (required) | |||||
| value | C | 0..1 | MoneyQuantity | An amount of money. With regard to precision, see [Decimal Precision](datatypes.html#precision) | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| value | SΣ | 1..1 | decimal | Numerical value (with implicit precision) | ||||
| comparator | ?!Σ | 0..1 | code | < | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented. | ||||
| unit | Σ | 0..1 | string | Unit representation | ||||
| system | ΣC | 0..1 | uri | System that defines coded unit form Required Pattern: urn:iso:std:iso:4217 | ||||
| code | Σ | 0..1 | code | Coded form of the unit Required Pattern: USD | ||||
| cost:coinsurance | S | 0..1 | BackboneElement | Coinsurance costs | ||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
| type | 1..1 | CodeableConcept | Type of cost Required Pattern: At least the following | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| coding | 1..* | Coding | Code defined by a terminology system Fixed Value: (complex) | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations | |||||
| system | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-BenefitCostTypeCS-TEMPORARY-TRIAL-USE | |||||
| version | 0..1 | string | Version of the system - if relevant | |||||
| code | 1..1 | code | Symbol in syntax defined by the system Fixed Value: coinsurance | |||||
| display | 0..1 | string | Representation defined by the system | |||||
| userSelected | 0..1 | boolean | If this coding was chosen directly by the user | |||||
| text | 0..1 | string | Plain text representation of the concept | |||||
| applicability | 0..1 | CodeableConcept | in-network | out-of-network | other Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers. | |||||
| qualifiers | 0..* | CodeableConcept | Additional information about the cost Binding: Qualifier for coinsurance rate (required) | |||||
| value | 0..1 | Quantity | The actual cost value | |||||
| id | 0..1 | string | Unique id for inter-element referencing | |||||
| extension | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url | |||||
| value | Σ | 0..1 | decimal | Numerical value (with implicit precision) | ||||
| comparator | ?!Σ | 0..1 | code | < | <= | >= | > - how to understand the value Binding: QuantityComparator (required): How the Quantity should be understood and represented. | ||||
| unit | Σ | 0..1 | string | Unit representation | ||||
| system | ΣC | 0..1 | uri | System that defines coded unit form Required Pattern: http://unitsofmeasure.org | ||||
| code | Σ | 0..1 | code | Coded form of the unit Required Pattern: % | ||||
| Documentation for this format | ||||||||
| Path | Conformance | ValueSet | ||||
| InsurancePlan.meta.security | extensible | All Security Labels | ||||
| InsurancePlan.meta.tag | example | CommonTags | ||||
| InsurancePlan.language | preferred | CommonLanguages
| ||||
| InsurancePlan.status | required | PublicationStatus | ||||
| InsurancePlan.type | extensible | InsuranceProductTypeVS | ||||
| InsurancePlan.contact.purpose | extensible | PlanContactTypeVS | ||||
| InsurancePlan.contact.name.use | required | NameUse | ||||
| InsurancePlan.contact.telecom.system | required | ContactPointSystem | ||||
| InsurancePlan.contact.telecom.use | required | ContactPointUse | ||||
| InsurancePlan.coverage:drug-coverage.benefit.type | extensible | InsurancePlanType | ||||
| InsurancePlan.plan.type | extensible | InsurancePlanType | ||||
| InsurancePlan.plan.specificCost.benefit.cost.applicability | required | BenefitCostApplicability | ||||
| InsurancePlan.plan:drug-plan.specificCost.category | extensible | PharmacyBenefitTypeVS (a valid code from Codes for pharmacy benefit types) | ||||
| InsurancePlan.plan:drug-plan.specificCost.benefit.type | extensible | DrugTierVS (a valid code from Codes for medication drug tiers in health plans) | ||||
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost.type | extensible | BenefitCostTypeVS (a valid code from Codes for benefit type of cost) | ||||
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost.applicability | required | BenefitCostApplicability | ||||
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.applicability | required | BenefitCostApplicability | ||||
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.qualifiers | required | CopayOptionVS | ||||
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost:copay.value.comparator | required | QuantityComparator | ||||
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.applicability | required | BenefitCostApplicability | ||||
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.qualifiers | required | CoinsuranceOptionVS | ||||
| InsurancePlan.plan:drug-plan.specificCost.benefit.cost:coinsurance.value.comparator | required | QuantityComparator |
This structure is derived from InsurancePlan
Summary
Mandatory: 15 elements (2 nested mandatory elements)
Must-Support: 30 elements
Structures
This structure refers to these other structures:
Extensions
This structure refers to these extensions:
Slices
This structure defines the following Slices:
Other representations of profile: CSV, Excel, Schematron
IG © 2022+ HL7 International / Pharmacy. Package hl7.fhir.us.davinci-drug-formulary#2.0.1 based on FHIR 4.0.1. Generated 2023-12-01
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